Strategy for a Change

As the health care world changes over the next five years, leaders will need to develop and articulate strategies that move their institutions toward success. Their instinct will be to create plans that focus on maintaining what they have done in the past: providing the same services to the same clients, with the same delivery structures and being paid in the same way. Such an approach will not lead to much change and it will not make a significant contribution to the overall improvement of care in the US. If truth is told, such efforts will not even contribute to the long-term successful positioning of their institution. Health care leaders should take the time to develop the ability to ask more fundamental questions about all of what their organization does, but four particularly critical areas are: business model, practice model, human resources, and partnerships.

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Buy-In

It is the most common question I am asked these days in leadership development sessions: How do I get buy-in? It is not surprising given the nature of the challenge that health care leaders face. We are confronted with the need to bring almost tectonic changes to an enormous $2.6 trillion industry that for the past half century has been left to chart its own independent way. The challenges include bringing new models of care delivery online, using comprehensive new technology to manage information, joining with new partners to integrate care along a continuum, responding to the consumer needs of patients and always delivering better service while reducing costs.

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How Will We Get There? Part Two

I had a large number of responses to last month’s essay on how we will execute the health care reform. Not “execute” as in do away with, I had more of “bring to life form” of executing in mind. My basic premise here is that reducing access to care as a way of controlling cost or reducing the payment for specific inputs is not a sustainable pathway for reform. It will be difficult if not impossible to do and moreover, will not bring the level of reductions in cost and improvements in service that are needed. This is a strange alchemy I realize, reducing cost and improving quality, but we do it on other parts of our economy: think Southwest Airlines here.

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How Will We Get There?

How will we get there? The task is pretty daunting, but most of the people I speak with these days about health care are committed to changing things; they just don’t know how to take the first step. Or they see the specific thing to do, but do not have a good grasp on the framework that needs to surround the improvement or reform that is just in front of them. Here is a quick review of the challenge and what leaders need to do to sustain the change process.

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Growing with Conflict

It should go without saying that as the health system changes over the next decade, it will produce considerable conflict. At the macro level, the broad sweep of the change means doing more with less. Such a change is always a prescription for tension. And if this process involves changing the ways we organize and deliver health care to get a better, less expensive process, rather than just cutting budgets, then it will involve adapting and adjusting to a new paradigm for health care. Any time you stomp around on someone’s long held revealed truth, conflict is always a byproduct. So if your leadership is hitting the mark of significance, you will know because you will notice the steam around you.

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What's Next?

At a recent talk on health care’s future I carefully laid out what I believe to be the five most significant drivers of health care change: 1) cost of care, 2) uneven patterns of use, quality and safety, 3) aging population, 4) shifting disease trends from acute to chronic, and 5) dramatic changes in consumer understanding and demand for care. I then pointed to the opportunity these trends created as the enormous $2.5 trillion US health care system searched for new ways to meet these shifting demands. Moreover, though not perfect, the market and policy drivers were more aligned than ever across health care, presenting even more opportunity for individuals, organizations and professions to realign themselves to meet the emerging needs. One of the best questions following the talk went something like this: This all sounds right, but who, specifically, will actually do this work to remake the system? It is a good question because it focuses us all on the next step and hard work that lies ahead.

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What's in a Vision?

As health institutions position themselves to respond to the policy and market driven demands of the emerging health care system, leaders in every setting are challenged to create new visions to help shape the future. We commonly think of a vision as that bright and shiny future state in which every problem has been addressed and everyone is happy. Leaders should get over such messianic impulses.

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Four New Frames for Health Care

For the past half century, the US has assembled a remarkable set of cultures, institutions, and practices to organize, deliver and finance health care. Each year, tens of thousands of the best and brightest of each generation accept the demanding challenge to enter one of the pathways to become the next generation of leaders within these amazing arrangements for health. In large American cities, the aggregation of these health centers takes up multiple city blocks, and they are often the largest employer, and a place where world class research, patient care and education come together in the service of society. There is no less pride in small town America, where the local hospital, staffed with graduates from the big city health center, is often the tallest building on the horizon; and parents take pride that their sons and daughters have found a good job in the helping business. These citadels of health, large and small, have come to represent many of the good things of life: helping others, growing and applying knowledge, having a career, being responsible. The truth is that in the walls of these shining cities on the hill miracles do happen and lives are saved. In gratitude and hope we have left behind larger and larger financial gifts as recompense at their doors.

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Phases of Reform

There are four big things that are done to produce heath: prevention, diagnosis, treatment and management. Prevention has great leveraging ability to bring about enormous change in health status, but its impact is felt over a long time horizon and we do not have a complete set of tools to drive changes in individual behavior -- which is key to effective prevention. Moreover, the public policies needed to fully engage all effective preventive strategies can intrude on individual freedom and choice, raising an array of political issues. Of course, most of the focus of the current US health care system is on the diagnosis and treatment of disease, including training and payment. Finally, management of disease, particularly chronic disease, is an effective, but underutilized component of the overall health landscape in our country. Switching from managing the nation's large and growing chronic disease burden from our expensive acute care practice models to new management modalities in the community has been demonstrated to lower costs significantly, improve the quality and safety of the care and, when fully understood, enhance the patient's experience as a consumer.

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Health Care Environment Drivers

The Center for the Health Professions sponsors a large number of leadership development programs in health care. An essential part of these programs is to help participants understand the changing environment, and to assist them in developing responses so that their organizations can be strategically successful. I am frequently asked by my colleagues if there was a single, short document that summarizes that changing environment facing all of health care. There isn't, so I'm taking this opportunity to try to remedy that situation. What follows is my list of some of the most critical issues, developments, and concerns in the health care environment now and in the future. Grasping them from the perspective of your practice, hospital, clinic, group, school, company or agency will be an essential first step in being a transformational leader.

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